The previous Lancet Seminar on suicide was published in 2009. We searched PubMed and the Cochrane Library from Jan 1, 2009, to May 30, 2015, with the terms suicide, suicidal behaviour, and self-harm along with category-specific terms, including epidemiology, genetics, intervention, prevention, and psychotherapy. Titles and abstracts of search results were read and sorted to assess inclusion of the article. We identified further articles by scanning the reference sections of selected
SeminarSuicide and suicidal behaviour
Introduction
Suicide takes a staggering toll on global public health, with almost 1 million people dying from suicide worldwide each year.1 WHO has declared that reducing suicide-related mortality is a global imperative, a welcome contrast to the traditional taboo that has surrounded suicidal behaviours. Cultural and moral beliefs about suicide, and unnecessarily pessimistic views about treatment and prevention of suicide, are barriers to patient self-disclosure and clinicians' routine inquiries about suicidal thoughts. About 45% of people who die by suicide consult a primary care physician within 1 month of death, yet documentation of physician inquiry or patient disclosure is rare.2 We review the epidemiology, risk factors, and effective interventions in primary care and specialty mental health facilities aimed at the prevention or treatment of suicidal behaviour.
Section snippets
Definitions and assessment
Clear discussion, accurate research, and efficient treatment require accepted definitions of suicidal behaviours. The difficulty of establishing intent of self-harming behaviours has hindered efforts to streamline the historically heterogeneous suicide nomenclature, but efforts, such as those resulting in the Columbia Classification Algorithm of Suicide Assessment,3 have contributed to standardising nomenclature (table). The severity of suicidal behaviour varies, on the basis of family studies
Epidemiology
Precise global estimates of suicide rates are difficult to obtain, as only 35% of WHO member states have comprehensive vital registration with at least 5 years of data.1 Globally, an estimated 11·4 suicides per 100 000 people occur per year, resulting in 804 000 deaths.1 Suicide rates vary within and between countries, with as much as a ten-times difference between regions; this variation is partly correlated with economic status and cultural differences.1 Cultural influences might trump
Contemporary models of suicide risk
In the past century, the contributions of both social and individual factors to understanding suicide risk have been recognised. Several models have been proposed, most emphasising the interaction between predisposing and precipitating factors.17, 18, 19, 20 Figure 2 shows putative temporal relationships between different suicide risk factors. Suicide has many causes, with substantial variability in the strengths and patterns of association of risk factors across sex, age, culture, geographic
Population-level risk factors
More than a century ago, Durkheim recognised the effect of population-level social factors on suicide rates. Increases in suicide rates among indigenous peoples, such as Canadian Inuits, correlate with social changes such as forced settlement, assimilation, and disruption of traditional social structure.6 Conversely, suicide is rare in homogeneous societies with high social cohesion, common values, and moral objections to suicide,23, 24 although the latter might also lead to under-reporting.
Prevention
Several reviews of the efficacy of different prevention practices have been published.100, 101, 102, 103 School, workplace, and community-based interventions, and multicomponent primary care interventions, can reduce the incidence of suicide or suicidal behaviour, as can the organisation of and access to care, and reduced access to means of suicide.
School-based interventions reduce the incidence of suicide ideation or suicidal behaviour. The Good Behaviour Game, a teacher-led classroom
Perspectives
Suicidal behaviours are heterogeneous, both in terms of presentation and treatment, making it difficult to provide an all-encompassing model of suicide risk or to suggest a clear treatment formula. Because of the complexity and the breadth of the subject, we present an overview of the present state of knowledge in suicide research. Certain aspects, such as detailed discussions of the psychology of suicide and suicide prevention, have been well described elsewhere.17, 141 Ongoing advances in
Search strategy and selection criteria
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